related conditions

Sex After 50

They say that 50 is the new 40. What they don't say is that while you might act and feel younger at 50 than your mother did even at 40, your body is still 50 years old. That typically means a significiant drop in estrogen levels. Beyond the hot flashes and night sweats, such a decline can also lead to changes in your sexual function and reproductive system.

As you probably know, sex starts in the brain, not the vagina. And the part of the brain responsible for sexual function and mood—the hypothalamus—is a hotbed of estrogen receptors. That means estrogen, along with testosterone, likely plays a role in your initial desire.

And, it turns out that estrogen is to your vagina what moisturizer is to your face—and more! It's critical for keeping things moist, healthy and flexible down there. The vagina, clitoris, urethra (the tube leading from the outside of your body to the bladder), bladder and other urogenital components all contain significant numbers of estrogen receptors. That means they rely on estrogen for healthy functioning. As estrogen levels decline and less reaches these tissues, they literally atrophy or shrink, not just dry up—sometimes resulting in a significant negative effect on your sex life.

Let's start with the vagina. Without sufficient estrogen, it becomes dry and less acidic, increasing the risk of infection. It takes longer to get lubricated for sex, even if you're ready and full of desire. Over time, estrogen deficiency can lead to more significant changes in the entire urinary/genital area, including reduced blood flow to the vagina, and the tissue itself becomes thin and weak. The result: dryness, irritation and pain upon intercourse, also called dyspareunia.

Estrogen loss also can lead to changes in the size and sensitivity of the vulva, vagina and clitoris, as well as reducing blood flow to these areas.

Estrogen isn't the only hormone you need to worry about, however. Testosterone also plays a role in your sexual desire and satisfaction. Unlike estrogen, testosterone levels don't suddenly plummet at menopause, but, rather, decline gradually beginning in your mid-20s. By the time you reach menopause, your body is producing about half as much as it did when you were in your 20s.

Researchers are still debating testosterone's role in women's sexuality. They think it contributes to blood flow and arousal of the clitoris and labia (the tissue around the vagina) which, in turn, contributes to arousal and orgasm. Hormone receptors are prevalent in the hypothalamus, the part of the brain that controls sexual function and mood. So, it appears that both estrogen and testosterone may influence getting a woman "in the mood."

But the precise role of testosterone in female sexual desire is still being determined. Although most studies confirm that testosterone is strongly related to sexual drive, the correlation between sexual problems and low levels or testosterone is inconsistent (that is, testosterone levels do not predict sexual desire levels). More research is needed to define the significance of testosterone levels in women and what constitutes "normal" testosterone levels in postmenopausal women.